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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701171
Report Date: 07/21/2022
Date Signed: 07/26/2022 12:59:48 PM

Document Has Been Signed on 07/26/2022 12:59 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:RAMENDRA & KAMLA PRASAD'S ARFFACILITY NUMBER:
502701171
ADMINISTRATOR:RADAZA, RODOLFOFACILITY TYPE:
735
ADDRESS:12091 E. WHITMORE AVETELEPHONE:
(209) 324-8355
CITY:HUGHSONSTATE: CAZIP CODE:
95326
CAPACITY: 4CENSUS: 0DATE:
07/21/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Mukesh and Vinorma PrasadTIME COMPLETED:
03:30 PM
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Announced Prelicensing visit made out to this facility on 07/21/2022 by Licensing Program Analysts (LPAs) Charlie Yang and Arielle Pascua who were met by the Applicants, Mukesh and Vinorma Prasad, who were briefly interviewed.
The Applicants are seeking licensure for a 4-bed ARF to accept and retain Level 4I residents vendorized through Valley Mountain Regional Center.
Current census was zero residents.
Tour of this facility was conducted along with the Applicants.
Kitchen area was toured. Drawers and cabinets were opened and reviewed.
Medication cabinet, located in kitchen area, was reviewed. It was observed to be equipped with a locking mechanism that would make it inaccessible to the residents at all times.
Food supply was reviewed for adequate 2-day perishable and 7-day nonperishable food quantities. Food storage units were reviewed.
A tour of the resident bedrooms was conducted. It was observed that bedroom furniture and furnishings were sufficient and able to meet the needs of the residents at this time.
A tour of the resident restrooms was conducted. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees.
Living area, dining area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time.
Fire extinguishers, located throughout this facility, were observed to have been purchased on 03/26/2022 with the receipt attached.
Linen closet was observed to contain a sufficient supply of towels, sheets, and linens for resident use at this time.
A review of the facility office area was conducted. Sample files were set up for facility resident and staff.
First aid kit was observed to be present and contained all of the necessary components at this time.
A tour of the facility exterior grounds was conducted. LPAs observed that there was a garage located in the
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: RAMENDRA & KAMLA PRASAD'S ARF
FACILITY NUMBER: 502701171
VISIT DATE: 07/21/2022
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backyard of this facility. It was stated by the Applicant that this garage will not be used for any storage or be opened at any time to facility staff or residents alike. It was observed to be locked and made inaccessible to the residents at this time.
A review of the perimeter fence was conducted.

Based on today's Prelicensing visit it was observed that this facility was found to be in compliance at this time.
Component III was waived during the course of this visit.

There were no deficiencies observed or noted during today's Prelicensing visit.

Exit Interview
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
LIC809 (FAS) - (06/04)
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